AHIP TRAINING Medicare Fraud, Waste, and Abuse Training Exam Questions and Answers Latest Update
AHIP TRAINING Medicare Fraud, Waste, and
Abuse Training Exam Questions and
Answers Latest Update
Question 1
Medicare plan means
Correct Answer
A MA plan, MA-PD plan or PDP
Question 2
Subcontractor means
Correct Answer
**An individual or entity that provides services on behalf of a Medicare plan
sponsor. This includes individuals and organizations with DIRECT relationship with
the plan sponsor or individuals or organizations with INDIRECT relationship, such as
an agent who has a contract with an agency or filed marketing organization that
contract with a Medicare plan.
Question 3
FWA Training: A compliance program component
Correct Answer
**ALL Medicare plans are required to have robust programs to assure compliance
by plan employees an subcontractors with all applicable laws, regulations and
program guidance.
**One required component of a compliance program is a FWA program to identify
and address issues of compliance with FWA.
**It is important to remember that ALL Medicare plan sponsor employees and
subcontractors are responsible for complying with all relevant Medicare
requirements, even if lack of compliance may not be viewed as FWA,
Page 1 of 17
,AHIP TRAINING Medicare Fraud, Waste, and Abuse Training Exam Questions and Answers Latest Update
Question 4
FWA: Why participate in the training
Correct Answer
**Fraud, waste and abuse impacts everyone who receives or relies on healthcare in
the US.
**The purpose of this training is to help you detect, correct and prevent FWA and
your help is needed. You are part of the solution!
**As a subcontractor to or an employee of a Medicare plan, you are required to
participate in FWA training.
Question 5
FWA: Combating: A federal priority
Correct Answer
**Important priority for the Federal Government.
**CMS, the Federal agency responsible for administering these programs, takes its
role in leading anti-fraud efforts very seriously and has issued strict requirements
for those involved in providing MA and Medicare Part D coverage.
**The office of Inspector General, a sister agency to CMS within the US Department
of Health and Human Services , is also actively involved in anti-fraud efforts.
Question 6
Steps by Medicare plans to Combat FWA
Correct Answer
--The establishment and operation of special investigation units (SIU) or other
existing departments that perform an internal investigation function
--The analysis of claims data
--Collaboration with law enforcement agencies
--Adherence to rules set forth by CMS regarding efforts to identify and prevent
fraud, waste and abuse.
Page 2 of 17
, AHIP TRAINING Medicare Fraud, Waste, and Abuse Training Exam Questions and Answers Latest Update
Question 7
CMS Anti-FWA requirements for Medicare plans
Correct Answer
--Actively seek to prevent fraud, waste and abuse
--Detect and investigate suspected FWA
--Implement corrective action when instances of FWA are uncovered
--Have a system in place 24 hrs per day for employees and subcontractors to
voluntarily, and confidentially report suspected FWA or misconduct related to the
MA and Part D programs
Question 8
CMS FWA training requirements for a Sponsor's Employees
Correct Answer
**CMS requires Medicare plan sponsors to provide training in FWA to their
employees involved in Medicare plan work.
**This training must occur within 90 days of hire and annually thereafter.
Question 9
CMS FWA training requirements: Agents, Brokers and other Subcontractors
Correct Answer
**The FWA training must be received not only by Medicare plan sponsor employees
but also by subcontractors and their employees who are under contract to provide
health or administrative services. The EXCEPTIONS are limited to:
***accredited suppliers of DME, prosthetics, orthotics, and supplies (DMEPOS)
***Healthcare providers who are enrolled in Medicare Part A/B
Question 10
CMS FWA training requirements: Agents, Brokers and other Subcontractors
Those required to take the training including, but not limited to:
Correct Answer
--Insurance agents, brokers as well as employees of agencies and field marketing
organizations that are performing services for Medicare plans
--Employees of other vendors and subcontractors (such as claim processing firms)
--Pharmacies and employees of Pharmacy benefit Managers
Page 3 of 17
AHIP TRAINING Medicare Fraud, Waste, and
Abuse Training Exam Questions and
Answers Latest Update
Question 1
Medicare plan means
Correct Answer
A MA plan, MA-PD plan or PDP
Question 2
Subcontractor means
Correct Answer
**An individual or entity that provides services on behalf of a Medicare plan
sponsor. This includes individuals and organizations with DIRECT relationship with
the plan sponsor or individuals or organizations with INDIRECT relationship, such as
an agent who has a contract with an agency or filed marketing organization that
contract with a Medicare plan.
Question 3
FWA Training: A compliance program component
Correct Answer
**ALL Medicare plans are required to have robust programs to assure compliance
by plan employees an subcontractors with all applicable laws, regulations and
program guidance.
**One required component of a compliance program is a FWA program to identify
and address issues of compliance with FWA.
**It is important to remember that ALL Medicare plan sponsor employees and
subcontractors are responsible for complying with all relevant Medicare
requirements, even if lack of compliance may not be viewed as FWA,
Page 1 of 17
,AHIP TRAINING Medicare Fraud, Waste, and Abuse Training Exam Questions and Answers Latest Update
Question 4
FWA: Why participate in the training
Correct Answer
**Fraud, waste and abuse impacts everyone who receives or relies on healthcare in
the US.
**The purpose of this training is to help you detect, correct and prevent FWA and
your help is needed. You are part of the solution!
**As a subcontractor to or an employee of a Medicare plan, you are required to
participate in FWA training.
Question 5
FWA: Combating: A federal priority
Correct Answer
**Important priority for the Federal Government.
**CMS, the Federal agency responsible for administering these programs, takes its
role in leading anti-fraud efforts very seriously and has issued strict requirements
for those involved in providing MA and Medicare Part D coverage.
**The office of Inspector General, a sister agency to CMS within the US Department
of Health and Human Services , is also actively involved in anti-fraud efforts.
Question 6
Steps by Medicare plans to Combat FWA
Correct Answer
--The establishment and operation of special investigation units (SIU) or other
existing departments that perform an internal investigation function
--The analysis of claims data
--Collaboration with law enforcement agencies
--Adherence to rules set forth by CMS regarding efforts to identify and prevent
fraud, waste and abuse.
Page 2 of 17
, AHIP TRAINING Medicare Fraud, Waste, and Abuse Training Exam Questions and Answers Latest Update
Question 7
CMS Anti-FWA requirements for Medicare plans
Correct Answer
--Actively seek to prevent fraud, waste and abuse
--Detect and investigate suspected FWA
--Implement corrective action when instances of FWA are uncovered
--Have a system in place 24 hrs per day for employees and subcontractors to
voluntarily, and confidentially report suspected FWA or misconduct related to the
MA and Part D programs
Question 8
CMS FWA training requirements for a Sponsor's Employees
Correct Answer
**CMS requires Medicare plan sponsors to provide training in FWA to their
employees involved in Medicare plan work.
**This training must occur within 90 days of hire and annually thereafter.
Question 9
CMS FWA training requirements: Agents, Brokers and other Subcontractors
Correct Answer
**The FWA training must be received not only by Medicare plan sponsor employees
but also by subcontractors and their employees who are under contract to provide
health or administrative services. The EXCEPTIONS are limited to:
***accredited suppliers of DME, prosthetics, orthotics, and supplies (DMEPOS)
***Healthcare providers who are enrolled in Medicare Part A/B
Question 10
CMS FWA training requirements: Agents, Brokers and other Subcontractors
Those required to take the training including, but not limited to:
Correct Answer
--Insurance agents, brokers as well as employees of agencies and field marketing
organizations that are performing services for Medicare plans
--Employees of other vendors and subcontractors (such as claim processing firms)
--Pharmacies and employees of Pharmacy benefit Managers
Page 3 of 17
